The Scientific Activist

A Tale of Two Health Care Systems

Mike Dunford tells a compelling story today at The Questionable Authority:

Yesterday, I took the kids to the doctor for their school physicals. I wouldn’t normally subject you to an account of the day-to-day minutia of my personal life, but given the current debate about how we should handle health care in the United States, the details might be of interest.

We arrived – without an appointment – at a medical facility that we had not been to before. We did not have medical records with us, and the only paperwork of any kind that we had brought were the forms that needed to be filled out to enroll the kids in sports programs. When we checked in, the only thing I had to do was hand the clerk a government-issued photo ID. I did not have to fill out any insurance forms, I did not have to hand over any payment of any kind, and I didn’t touch a clipboard. Within two hours, both the children had been seen by a doctor, received physical exams, had their shot records checked and brought up to date where necessary, and I’d been given the completed school and sports forms.

That’s not fiction, and it’s not a prediction of what could happen in the future. That happened yesterday, it happened in the United States, and it happened in a health care system that’s owned and operated by the Federal Government.

That’s right. I got to use the dreaded socialized medicine yesterday, because I’ve got access to the Department of Defense’s medical system.

We didn’t have to fill out forms yesterday because all the paperwork that needed to be done to switch our primary care doctor from one in Florida to one in Alabama was done when my wife checked in to her new assignment. We didn’t need to bring records, because both facilities have access to the same electronic system. All that the clinic needed to access the records was my wife’s information.

I mention this because it reminded me so much of something I wrote about previously on my blog:

I had a great trip to the doctor the other day. I showed up for my appointment (one I had made only one day before), waited a few minutes, saw the doctor, and then I left. There was no paperwork, no long wait, no money exchanged, and no stress. Basically, there was nothing standing in the way of what I had come there for–medical care.

And, no, I don’t live in some fantasy world.

I live in England.

I love universal health care, and for me it’s because of the small things. I never had any major problems with my health insurance in the U.S., but I still had to fill out a ton of paperwork every time I went to the doctor, I couldn’t always see the doctor I wanted to see, and I had to pay those really annoying co-payments. At least I had health insurance in the U.S., though, unlike over the millions of people left without coverage in the richest nation in the world. For these people, universal health care isn’t about convenience: it’s about life and death.

These two stories take place in totally different parts of the world and under very different circumstances, but the one thing they have in common as that the both involve typically positive experiences with nationalized… or, dare I say, socialized… medicine. There is nothing unique about these stories, as these sorts of events happen to people across the globe daily. You just rarely hear about them.

In fact, that the spectre of socialized medicine–with all of the obligitory cherry-picked horror stories–has been raised at all in regards to the current health care reform efforts says much more about the unfortunate state of political dialogue in the US than it does about differences in medical care. Let’s get one thing straight: socialized medicine is not even on the table right now. And, that’s incredibly unfortunate, as the greatest problems with the American system stem from the incredible inefficiency and constant confusion that comes from a market-based system sporting a patchwork of equally unappealing and often unaccessible private insurance options. Whatever form health care reform finally takes, America will still have the most conservative, privatized, and inefficient health care system of all Western industrialized nations. The political dialogue in the US is just so incredibly skewed to the right that special interests are able to fight tooth and nail against these very meager reforms–and do it effectively.

It’s true that socialized medicine is no panacea for all of society’s health care-related problems. Just as Mike is very forthcoming about the shortcomings of the socialized medicine he has experienced, I’ll be the first to point out the problems with the British system. Namely, it’s underfunded. If we in the US spent what we spend now on a nationalized system, it would put the British medical system to shame. Big time.

Despite the skepticism I’ve expressed about current health care reform efforts in the US, though, let me be perfectly clear: it is of great importance that such reforms happen now in whatever form they take. True comprehensive change on this front in the US is going to have to be incremental. That’s made all the more obvious by the more-visible-than-usual congressional sausage-making factory that has been on display over the last couple of months, as Republicans and conservative Democrats do everything in their power to stall meaningful reforms. Regardless, the situation in the US is so dire that any move in the right direction is something to be embraced openly.

The worst thing we could do would be to stick with the status quo.

Comments

  1. #1 Dawn
    August 6, 2009

    Paperwork isn’t scary or hard. I have to fill out forms when I see a new doctor. Either I fill out forms or I give a verbal history of my life and health. Socialized health care can never take this step away as doctors need demographics, histories, and medicine lists. When the office is computerized, it is timesaving, but it all still has to be recorded somewhere. In fact, it serves a purpose. Most paperwork invovles demographics, you are indeed number 35. Do you want number 45′s health care record? He has a brain tumor.
    As far as insurance and payment, stop being so cheap. My personal experience with military healthcare (US) proves that government healthcare should never be an option. I should have paid for civilian health care it would have cost but I might have avoided a nightmare.
    I am more concerned about quality with health care. I will stick with speed for oil changes only. Quality means time and money. Reforming health care happens all the time. Some CEO will get a brillant idea to computerize records and reform health care. Oh that’s right this has happened. We need to find ways to fill in gaps for coverage not assume government responsibility. How are Hawaii and Illinois doing with their healthcare for all schemes?

  2. #2 BobQ
    August 6, 2009

    obligitory cherry-picked horror stories

    Same thing is done for the current US system.

    but I still had to fill out a ton of paperwork every time I went to the doctor

    Case in point. All I fill out at my doctor visits is the sign in sheet.

    It’s not that people don’t trust government to manage the system, it’s that they don’t trust *THIS* government (The US Government in general, not any particular Administration) to manage it. I know it’s all the rage here to exempt one major political Party from skeptical analysis, but I’m afraid I can’t do that. Face it, we have a pack of low wattage bulbs in charge in both major Parties. I know people who wholeheartedly support full on socialized health care, and *they* hate the current bill and do not trust it.

    All the happy stories from other countries are great, but we have a completely different situation here. I’m glad the kids got their physicals and shots. What happens when an X-Ray reveals a difficult brain tumor? What happens when dad begins to get mysterious symptoms that would baffle anyone less than Dr. Gregory House? How about when 75 year old grandpa, who is sharp and clear and still enjoying life, needs some sort of expensive and/or exotic operation?

    The EU systems cost less per capita. Will that happen here? Can anyone back that up with a solid analysis?

    Is it so wrong to ask questions?

    I have no ideological horse in this race. If socialized medicine could he handled well in this country, then fine. But what Congress is doing now is just a mess.

  3. #3 nico
    August 6, 2009

    I live in canada, and I’ve never lacked for thorough, competent, skilled care.

    If you’re conflating efficiency for “sloppy”, Dawn and BobQ, then you’re mistaken.

    Once i’ve seen a doctor, I don’t have to deal with reams of paperwork on subsequent visits, nor do they have to submit myriad pieces to different insurers. The offices are clean, efficient, the staff are exemplary. I never have to wrangle with insurers or co pays.

    The US system now isn’t patient oriented, at all. It’s efficient at extracting money from customers, but not so much on the other end.

    Everyone I know has had rapid,top of the line emergent care. I’ve never had an issue getting next day, or same day appointments for a GP.

    And as for “what if they saw a brain tumor”, well, a friend started having seizures, a normal healthy adult, and the next day got an MRI, showing a massive brain abcess. He did wind up incredibly sick, very fast, but all his care, from first symptoms to ongoing rehabilitation now, has been covered by provincial and federal care. He couldn’t work, the last thing he needed in that situation was to wind up owing thousands, and facing battles with insurers.

    I’m happy to pay for that system. Odds are a US system would cost less, IF…IF people can resist the urge to micromanage it, and add layers of red tape, but on that front I’m skeptical that anyone would do such a simple program as “everyone pays in to one plan, everyone has access”.

  4. #4 MikeB
    August 7, 2009

    Dawn – ‘Socialized health care’ doesn’t mean a Stalinist grind and people dying in corridors. I live in the UK and overall, my healthcare is fine (I worked for the NHS for 5 years and I’ve seen it at its best and worse). I have no forms to fill in, no co-payments (very important when you have two small children), and no bills at the end of it, apart from some perscription charges (and if you are on benefits or the script is for children, then they are free). As for computerizing records, despite the relatively slow progress here in the UK, having worked in medical records a number of times, you certainly don’t want to rely on paper or the patients personal recollections alone.

    BoBQ – EU countries all have lower healthcare costs per capita, and they all have ‘socialised’ healthcare systems, yet high standards of care – this isn’t a mystery. If someone here in the UK has a brain tumour, then the system gets going very quickly (no hassle with insurance companies), and your hopefully seen by a specialist within the week (cancer cases have time targets – miss them and the NHS managers in charge have to answer for it). The fact that the patient might be a ’75 year old grandpa’ makes no difference.

    The irony is that the US spends about the same proportion of public money as the UK (and yes, the NHS has historically operated on the cheap), yet because of private healthcare costs, the lobbying of drug companies and a piecemeal approach of the type that was failing in the UK in the 1930′s, you end up with no better outcomes, less coverage and higher personal costs. Put it this way Dawn, do you like having to deal with insurance companies? If you do, stay with your current system. If you don’t….

  5. #5 Fair Trade
    August 7, 2009

    I listed to Bill Moyers talking to Wendell Potter – what an eye opener!
    It included the following:

    WENDELL POTTER: The industry has always tried to make Americans think that government-run systems are the worst thing that could possibly happen to them, that if you even consider that, you’re heading down on the slippery slope towards socialism. So they have used scare tactics for years and years and years, to keep that from happening. If there were a broader program like our Medicare program, it could potentially reduce the profits of these big companies. So that is their biggest concern.

    I hope America resists the onslaught from the insurance companies and chooses to offer all her citizens health care.

    Having read today – http://www.nextgenfoodus.com/34m-receive-food-stamps/ – that 1 in 9 Americans are claiming food stamps it’s the right time.

  6. #6 Cyn
    August 7, 2009

    I’ve read countless stories of insurance companies denying claims and people have died as a result.

    I can’t think of anything more immoral and yet, it’s rarely mentioned in the debate.

  7. #7 Gerry L
    August 7, 2009

    Those papers you have to fill out? Most important is the one you must sign that says you understand that if your insurer declines to pay for the care you receive, you will be responsible for paying — whatever they ask. We will not treat you unless you sign a “contract” to pay us any charge we deem reasonable.

    I’ll be seeing a specialist on Monday and have been told to arrive 30 minutes ahead of my appointment to do “paperwork.” We all know the drill.

  8. #8 cheap jordan shoes
    August 8, 2009

    know it’s all the rage here to exempt one major political Party from skeptical analysis, but I’m afraid I can’t do that. Face it, we have a pack of low wattage bulbs in charge in both major Parties.

  9. #9 DB
    August 8, 2009

    “As far as insurance and payment, stop being so cheap. My >>>personal experience< << with military healthcare (US) >>>proves<<< that government healthcare should never be an option.”

    Stop being so cheap says the idiot. I’m sure that crack advice will fix everything.

  10. #10 BobQ
    August 8, 2009

    EU countries all have lower healthcare costs per capita, and they all have ‘socialised’ healthcare systems, yet high standards of care

    Fine. I agree. My complaint is that this factoid is tossed out there without any context. As far as I can see, the current bill before Congress does not give us an EU style system. Would an EU style approach even work with our situation? The concerns I listed are what people are going to wonder about. As gimmicky as it sounds, asking the politicians if they’d submit to the same health care system *is* a fair question. Concern about the basic inefficiency of the US Federal Government *is* a fair concern.

    I voted for Obama, and I feel quite bad for the Congressfolks getting attacked by the legions of ignorant at the town hall meetings, but this “Hurry and and get a bill passed! Aaaaa! (Sam Kinnison scream)” on something as sensitive as health care is just a massive misfire. I just wish we could have a government that wasn’t always in a panic mode and slapping together giant Brobdignian bills.

    Our situation is broken, but it’s not a dire emergency. I’d advocate something quick and simple to cover those currently without coverage, and then a sane and rational program to carefully transition this country to some sort of single payer system, be it an EU system or something better tailored to our situation. I’m still open to anything. I’ve read papers from think tanks that detail new approaches to fully privatized systems that sound workable. Like I said, I have no ideological chip on my shoulder.

  11. #11 Max P.
    August 9, 2009

    For ten years I lived on Bolivar Peninsula in Texas (before the hurricane swept everything away) and that area is about as rural as it gets. For most Americans living in a non-urban environment, our choice in specialists is dictated soley by the insurer – there are no options. I got cancer, had surgery, survived… The only specialist that the insurance company would approve was 45 minutes further away from my house than another one, equally qualified, that was down the highway a piece. And y’know, the worst part of the entire experience – of cancer! – was dealing with the insurance company and trying to cough up the enormous co-pay demanded by the hospital before they would operate. Like I needed that extra grief. Sorry for the rant. At least I got treated. Lots of our citizens aren’t so lucky.

  12. #12 sinz54
    August 9, 2009

    Congress is past the point of debating health care reform in the abstract.

    It’s the bills now before Congress that are the subject of the debate now.

    And those bills describe health care “reforms” that will NOT control costs, that in fact will do nothing besides throw $1 trillion more at the currently uninsured. The Congressional Budget Office found almost nothing in ObamaCare that would control costs. It’s all about spending $1 trillion on medical welfare for the uninsured. Costs be damned.

    Beyond that:

    Obama and his supporters told us that the current health care system is “broken” (their word), costs are escalating, the situation is intolerable–we just gotta have major reform!

    Then they promised all Americans who already have private insurance (that’s 78% of the population) that they could keep what they have???

    So tell me: How do you control escalating costs of a system, if 78% of it stays exactly the same, while you spend $1 trillion more on the remaining 22% of it???

    And yet more:

    Obama reassured his liberal supporters that the so-called “public option” was just a steppingstone to a single-payer system, which is what they’ve been demanding for years. By offering premiums low enough to entice employers into forcing their workers into the public option.

    Then he turns around and “reassured” the rest of us that ObamaCare is not going to lead to single-payer. How do you square THAT circle?

    Too afraid of a backlash to state plainly what they are truly after (single-payer), Obama and his supporters have been reduced to hemming and hawing. While his Republican opponents are quite focused–they want no part of any of it.

    And that’s why Obama is losing the fight. They’re reduced to “reassuring” the American people that they’re not getting what Obama’s supporters dearly hope they will get!

    It’s now clear that Obama’s “hope and change” is built on a pile of evasions, lies, and duplicity.

  13. #13 Vale
    August 10, 2009

    Just a little comment to say that I really like your Blog!! It’s always a pleasure to read your posts and thanks for that!!

  14. #14 Susan
    August 13, 2009

    The only experience I have ever had with scary socialized medicine was when my daughters came down with chicken pox while we were on vacation in Toronto. We were given care even though we are not Canadian citizens, and were sent a bill for seven dollars. There were no forms to fill out, no waiting, no mention of payment up front.

    Even though I get Medicare and go to a non-profit for my medical care, I still spend hundreds of dollars every month on membership fees, co-pays, and medications. And I am one of the fortunate ones. The failures of our system are not an emergency as long as you have insurance you can afford, with a company that doesn’t deny necessary treatment. For anyone else in this country, it certainly is an emergency.

  15. #15 mpatter
    August 14, 2009

    Why is a dichotomy between socialised and private healthcare being created?

    The UK also has a private health care option – you can get expensive health insurance which pays for any poor-value treatment you like. Meanwhile, poor people aren’t left out of healthcare because the NHS is there for everyone.

    Even a nationalised health care system with flaws – like underfunding – leaves a sick person from the UK in a considerably better situation than an American without insurance. It’s not perfect, but it’s quite fair.

  16. #16 dp
    September 10, 2009

    Could it be that under a socialized system they don’t need paper work because it is already in a database? The problem in this country is that the current system is not sustainable. That being said we are not going to eliminate an industry (insurers) overnight so they will be part of any “reform”. Even the advocates of full private won’t pull the trigger on the uninsured, medicare, medicaid, or the VA. To enact that idea you leave the uninsured uncovered (talk about rationing) and likely to die (death panels anyone). So the “anti-reformers” are advocating for the status quo which is not sustainable and more people will find themselves on the public option (no insurance but covered because we won’t let people die). Maybe if we wait long enough it will be single payer (currently 40-60% of the system).